Patient:

39 y.o. AAF adm. 1/29/04

Dx:                  

Perforated Bowel Repair

 

Procedures:                            

Exploratory Laparotomy (found peritonitis and lg diverticulum of sigmoid colon), Bowel Resection c Colostomy

 

PMH:              

HTN, Asthma, EtOH Abuse, Aortic Insufficiency, Diverticulitis 

PSH:               

Cholecystectomy, 3 Cesarean Sections

 

MEDS:

Hydrocodone (analgesic, antitussive, narcotic: pain reliever, cough control)

Flurazepam (Sleep Aid)

Acetaminophen (analgesic, antipyretic: pain reliever)

Ringers Lactate and Potassium Chloride

Chloraseptic (cough relief)

Diphenhydramine (antihistamine, cough relief)

Metronidazole (IV – antibiotic)

Ciprofloxacin (IV antibiotic)

Ranitidine (IV antiulcer, anti-gerd, antisecretory)

Sodium Chloride add ampicillin (antibiotic)

Labetalol HCL (antihypertensive: relaxes blood vessels)

Ipratropium (bronchodilator, anticholinergic)

Albuterol (bronchodilator, sympathomimetic)

                       

Anthropometrics:

Ht: 5’7” (170cm)                

IBW: 135 (61kg)                 

BMI: 39.3 (severe obesity)

Wt: 250#  (113.6kg)

%IBW: 185% 

ABW: 164#  (74.4kg)

 

Nutritional Requirements:

Calories = BEE x 1.2 approx. 2200kcal

PRO = >124g (obesity 2.0 x IBW)

***albumin not drawn ***MD ordered consult; wt loss p wound heal.

 

 

 

Diet Order

NPO

NPO

NPO

NPO

CL

CL 25%

NAS (2/4)

Labs

1/29

1/30

1/31

2/1

2/2

2/3

Normal Range

BUN

27

22

19

18

16

 

5-25 mg/dl

Na

WNL

135-146 mmol/L

K+

3.0

3.4

4.0

4.0

3.7

 

3.2-5.0 mmol/L

Cl-

WNL

95-112 mmol/L

Glucose

121

118

123

88

90

 

70-115 mg/dl

Creatinine

WNL

0.5-1.5 mg/dl

Ca++

WNL

8.1-10.2 mg/dl

Amylase

110

62

---

---

---

----

20-90 U/L

WBC

14.2

22.0

20.2

13.6

12.0

11.3

4.8-10.8 k/cmm

RBC

4.57

3.68

3.48

3.31

3.37

3.33

4.1-5.3 m/cmm

Hgb

12.7

10.5

10.0

9.1

9.7

9.4

12-16.0 g/dl

Hct

39.7

31.2

29.6

28.3

28.5

28.4

37-47%

Platelet ct

463

340

333

301

317

295

150-350 k/cmm

MPV

7.6

7.6

7.0

7.3

7.4

7.0

7.4-10.4

RDW

15.7

16.9

16.3

16.5

16.5

16.6

<16.5

 

 

 

 

 

 

 

 

Lab notes: Amylase inc c perforated peptic ulcer, alcohol poisoning, acute cholecystitis

Glucose inc sepsis, dehydration, steroids/corticosteroids

BUN inc c dehydration, inc pro metabolism; K+ dec c alcohol abuse, steroids

WBC inc tissue injury; RBC dec c hemorrhage/sx; Hgb dec sx;

 

 

Assessment:  Severely obese 39YO AAF admitted to ER with abdomen pain having hx of HTN, asthma, aortic insufficiency, diverticulitis, and EtOH abuse.  Pt. underwent exploratory laparotomy and bowel resection c colostomy; NPO x 5d.  Protein needs are increased for wound healing. At moderate nutritional risk due to needed diet education (high protein followed by weight loss and low salt diet).

 

Plan:

Goal: educate pt. for optimization of healing and future care.

Plan:

1)      Obtain diet history and current intake.

2)      Educate patient on increasing protein intake.

3)      Educate pt on weight loss and low salt diet.

 

Post op pt interview: pt complains of bad taste in mouth due to meds.  PO intake 50% and increasing.  Expressed interest in education for wound healing and weight loss.  Diet hx obtained.

 

F/U consult/education:

1)      Increased protein needs and multivitamin (handout provided)

    1. Diet rationale
    2. Recommended foods/tips

2)      Wt. Loss/low salt diet p 3 mos (handout provided)

    1. Diet rationale
    2. Recommended foods/tips
    3. Foods to limit/avoid
    4. Seasoning guidelines

 

 

References:

 

Escott-Stump S. 2002. Nutrition and Diagnosis Related Care. Lippincott Williams & Wilkins: New York.

 

Mahan LK. & S. Escott-Stump. 2000. Krause’s Food, Nutrition & Diet Therapy. W.B. Saunders Co.: New York.